A client is treating in post-operative general ward. If the incisional area of the client's abdominal surgical area is weak, then what will be possible to happen when abdominal muscles contract and increases intraabdominal pressure?

1. A

   Evisceration

2. B

   Dehiscence

3. C

   Laceration

4. D

   Abrasion

Appeared in: PGIMS Rohtak NO - 2017

Explanation

• Dehiscence is the partial or total separation of the layers of a surgical wound.
• It is directly caused by factors that increase stress on the incision, such as coughing, vomiting, or straining, especially when the wound is weak due to factors like obesity, poor nutrition, or infection.
• The question describes the exact mechanism leading to the initial separation of wound edges, which is the definition of dehiscence.
• While evisceration can occur, it is a subsequent and more severe complication that happens after the wound has already dehisced.

Why Other Options Were Wrong

• Option A: Evisceration is the protrusion of internal organs from an incision. While it is a severe complication related to increased abdominal pressure, it typically occurs after dehiscence. Dehiscence is the initial separation of the wound.
• Option C: A laceration is a wound produced by the tearing of soft body tissue, often with jagged and irregular edges. It is typically caused by external trauma, not by internal pressure on a surgical site.
• Option D: An abrasion is a superficial wound where the top layer of skin (epidermis) is scraped off. It is a minor injury and is not related to the deep tissue separation of a surgical incision.

Related Visual

Clinical Relevance

• Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Post-operative wound complications, specifically the differentiation between wound dehiscence and evisceration as background academic context rather than a clinical decision trigger.
• Nurses must educate post-operative patients on how to splint their abdominal incision with a pillow when coughing or moving to reduce pressure and prevent dehiscence.
• Early recognition of dehiscence (e.g., a sudden gush of serosanguineous fluid) is critical for prompt intervention to prevent progression to evisceration, which is a surgical emergency.
• What if? If a patient states they 'felt something pop' after coughing and you see loops of intestine protruding from their abdominal incision, your immediate action is to cover the organs with a sterile saline-moistened dressing, place the patient in a low Fowler's position with knees bent, and call for immediate surgical assistance. This is a medical emergency.

How to Approach the Question

• First, analyze the clinical scenario presented in the question stem. Identify the key elements: a post-operative patient with a weak abdominal incision and an event that increases intra-abdominal pressure.
• Next, review the options provided. Understand the precise medical definition of each term: Evisceration, Dehiscence, Laceration, and Abrasion.
• Differentiate between the closely related terms. Recognize that both dehiscence and evisceration are potential complications, but they represent different stages of wound failure.
• Determine the initial event. The question asks what is possible when pressure is applied. The initial separation of the wound is dehiscence.
• Select the option that describes this initial event. Evisceration is a progression of dehiscence, making dehiscence the most accurate answer for the event described.

Concept Tested & Keywords

• Concept Tested: Post-operative wound complications, specifically the differentiation between wound dehiscence and evisceration.
• Stem keywords: post-operative, abdominal surgical area, weak incisional area, increases intraabdominal pressure
• Lead-in keywords: what will be possible to happen
• Clinical cues: The scenario describes the classic mechanism for wound dehiscence: increased intra-abdominal pressure (from muscle contraction) acting on a weak post-operative incision.

Question ID

QbAtkCNO2EM76TR5kYkC53

Copy ID

Reference Book

E6 Nursing Brunner Adult Health 3SA Vol 1 Part 1 p. 126-128

E6 Nursing Fundamentals Potter Perry 12e Part 6 p. 74-76

E6 Gynecology Williams p. 65-88